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FORM NO.AES003 <br /> _ SERVICE ORDER <br /> - NO. N 6-5)02' <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 Ll (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD02827 7036 1-888-603-8844 <br /> r <br /> DATE ONETIME PICK UP El YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE 1` -' CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# " <br /> "- '� AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> PO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES PPM, <br /> El NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. { �` . ;� F 3 f` �.. - <br /> NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City, CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502-CAL000161743-(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street-Santa Cruz, CA 95060-CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. .Fresno, CA 93722.CAD982446882-(510) 795-4400 <br /> 19 -DEMENNO/KERDOON -2000 N.Alameda Street-Compton,CA 90222•CAT080013352.(310) 537-7100 <br /> ❑ D1K DIXON.7300 Chevron Way*Dixon,CA 95620.CAT080012602.(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-2549 Scott Avenue•Chico, CA 95928-CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> iEC OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified,described. packaged, marked <br /> ECYCLED AT OUR SISTER COMPANY DEMENNO/KERDObN THE � P P Y <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, and labeled,and are in proper condition for transportation, according to the applicable regulations of <br /> the Department of Transportation._ <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> THER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RP.M.; X "- <br /> ND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.• cusTOMen SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> ONTAINS ANY PC.B'S. PRINT NAME <br /> l <br />